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Don’t be afraid of your colonoscopy, doctors say. It could save your life

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The Dose20:51How often should I be having colonoscopies?

Colorectal cancer is the fourth most common cancer in Canada, but if caught early, many people have a good chance of surviving. But screening for it is key. Dr. Jill Tinmouth, lead scientist at the colorectal cancer screening program at Ontario Health and gastroenterologist at Sunnybrook Health Sciences Centre, speaks with guest host Dr. Peter Lin about colorectal cancer screening.

For some, a colonoscopy might be scary; others just put it off as a time commitment that can wait. But physicians and advocates agree that it’s important that people not be afraid of the screening procedure and get it done.

“Whatever you think you’re going through for a colonoscopy is no comparison to going through multiple surgeries, chemo, all sorts of treatment and potentially dying from it and the stress not just on you [but] on your family,” said Barry Stein, president and CEO of Colorectal Cancer Canada.

Stein also survived colorectal cancer.

“I would say that’s the biggest incentive to do it.”

Colonoscopies are part of the screening process for colorectal cancer in Canada. Screening in most provinces and territories often starts with an at-home stool test for the average-risk person before a colonoscopy is done, when needed.

With colon cancer being the second most common cause of cancer death in Canada, doctors say it’s an important procedure to have when necessary to catch cancer early.

FITs like Nova Scotia’s are the common first step in colorectal cancer screening in Canada for the average-risk person. (Nova Scotia Health)

Treatable when detected early

A recently published study and subsequent headlines have sparked discussions about the effectiveness of colonoscopies in detecting colorectal cancer.

A randomized controlled trial’s results published in the peer-reviewed New England Journal of Medicine found that among those invited to do a colonoscopy, there was an 18 per cent reduction in later colorectal cancers and no significant reduction in deaths.

But many of those invited never followed through.

When only people who actually had the colonoscopy were analyzed, the study’s authors found the procedure reduced the number of colorectal cancers by 31 per cent and associated deaths by 50 per cent.

Some American experts stress the trial’s results should not be misinterpreted as evidence that a colonoscopy is a bad screening test. Like any test or procedure, there are limitations.

But research shows that when colorectal cancer is detected early, it is 90 per cent treatable, according to the Canadian Cancer Society.

Improving cancer screening rates in diverse communities

A Toronto community health centre that primarily serves Black and immigrant patients dramatically improved its cancer screening rates after launching a targeted campaign several years ago. Cancer screening rates tend to be lower in some diverse communities.

Recently released cancer prevalence data from the society shows that colon cancer is the fourth most diagnosed cancer in the country, but that it can be more survivable than other cancers like lung cancer when caught early.

“Colorectal screening has been a revolution, as well as fecal occult blood testing, to help diagnose colorectal cancer in an earlier stage,” said Dr. Christian Finley, a thoracic surgeon and professor at Hamilton’s McMaster University and a member of the Canadian Cancer Society’s cancer statistics advisory committee.

“Over a long period of time, this appears to have borne fruit and we’re seeing a change in the numbers and stage of cancers that we’re seeing.”

But if you or someone you know is still hesitant to get their colon examined, here’s what experts say you should know about colonoscopies.

Who should get screened

If you’re 50 to 74 years old and at average risk of getting colorectal cancer, you should be getting screened every two years, according to the Canadian Cancer Society.

In most provinces and territories, screening for colon cancer starts with an at-home poop test — commonly a fecal immunochemical test (FIT).

As part of the non-invasive FIT, a patient is required to collect a sample of their stool and ship it to a lab for analysis.

The FIT looks for blood in the stool, a common sign of colorectal cancer. Other signs include anemia (low blood count caused by low iron), unexplained weight loss, new diarrhea, new constipation and abdominal pain, gastroenterologist Dr. Jill Tinmouth told CBC’s The Dose guest host Dr. Peter Lin.

Before a colonoscopy is done, patients will need to drink a liquid solution to clean out their colon. (Jean-Paul Pelissier/Reuters)

If the FIT comes back abnormal, then colonoscopy is often the next step, said Tinmouth, who is also the lead scientist at the colorectal cancer screening program at Ontario Health.

If the FIT results are normal, then screening through the at-home test can be done every two years, she added.

People who are at high risk for colon cancer may need to be tested at a younger age or more frequently, according to the society.

If you’re 75 and older, the Canadian Cancer Society recommends people speak with their primary care provider on whether they should continue getting stool tests.

Prep for the test

The colon must be clean for a colonoscopy. This prep, as it’s known, is a “major inconvenience,” according to Harvard Medical School, that takes longer than the actual procedure — but is necessary for the colonoscopy to work.

Prep includes drinking a solution that will cause “bowel-clearing diarrhea.”

Patients will also need to eat a liquid diet at least a day before the colonoscopy.

“Having a clean colon is really important because … it’s a bit of a twisty, turny space and so getting all the stool out maximizes our ability to pick up polyps and to find cancers,” said Tinmouth.

The procedure

A colonoscopy is a quick day procedure often done by a gastroenterologist.

“The way colonoscopy works is it’s a long, skinny tube that’s flexible. It’s got a light and a camera on the end and we’re able to sort of look directly at the lining of the colon. And so you take a prep, you clean everything out and we get a very nice look using that instrument,” said Tinmouth.

 

Yukon Morning8:32Colonoscopies — when and why you might need one

You don’t have to post a video of your colonoscopy online like Canadian actor Ryan Reynolds, but routine colorectal cancer screening should be on your to-do list, says house doctor Raj Bhardwaj. Elyn Jones spoke with him to learn more.

A colonoscopy can also find polyps — which can sometimes be cancerous — that are removed during the procedure.

Often the patient is mild or moderately sedated for the colonoscopy so that they’re not uncomfortable, says Tinmouth.

If sedated for the procedure, the patient may not be able to drive for a period of time afterward.

Finley acknowledged it can be hard — especially for those with lower socio-economic status, who work marginal jobs, or have to get childcare — to find time to get the procedure done.

“They don’t have the luxury of taking time off work to get those tests,” he said, adding the Canadian Cancer Society’s recent study on cancer prevalence shows that for colorectal and lung cancer, lower-income patients are much more likely to be newly diagnosed but are less likely to survive compared to wealthier patients.

“One of the big things we see in this study is it’s not a level playing field for people.”

How effective is a colonoscopy?

There is significant research showing that screening reduces the number of colorectal cancer diagnoses and deaths by finding precancerous polyps and early-stage tumours before symptoms begin.

Tinmouth emphasizes that colonoscopies are just one way to screen for colorectal cancer.

She adds that the recently published study on colonoscopies’ effectiveness “gives you an idea of how it’s a good test, but it’s not a perfect test.”

In most provinces and territories, routine screening for colorectal cancer for the average risk person starts at the age of 50 with an at-home poop test. (Submitted by Donna Hatt)

Other doctors have also noted that only 42 per cent of the 28,220 people invited to get the colonoscopy done as part of the study actually had the procedure done.

What if I’m uncomfortable or afraid of the procedure?

Stein and Tinmouth agree that people shouldn’t be afraid of colonoscopies.

“I think people get embarrassed and shy about the bowels, poop and all of that kind of stuff,” said Tinmouth.

“But really these are, as my mom would say, normal bodily functions. Everybody has them and does them.”

Stein was diagnosed with colorectal cancer that spread to his liver and lungs in 1995 and was told he had a 15 per cent of surviving the next five years of his life.

Now living with no evidence of the disease, he encourages people to keep up on their routine screening.

“From a practical point of view, [it’s] what we know will save lives and reduce the risk of going through what I went through — thirteen surgeries, all sorts of cancer treatments and being told that I was going to die and have a five-year survival and so forth,” he said.

“To avoid all that pain, suffering, the stress on your family, doing a simple screening test is nothing.”

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What’s the greatest holiday gift: lips, hair, skin? Give the gift of great skin this holiday season

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Give the gift of great skin this holiday season

Skinstitut Holiday Gift Kits take the stress out of gifting

Toronto, October 31, 2024 – Beauty gifts are at the top of holiday wish lists this year, and Laser Clinics Canada, a leader in advanced beauty treatments and skincare, is taking the pressure out of seasonal shopping. Today, Laser Clincs Canada announces the arrival of its 2024 Holiday Gift Kits, courtesy of Skinstitut, the exclusive skincare line of Laser Clinics Group.

In time for the busy shopping season, the limited-edition Holiday Gifts Kits are available in Laser Clinics locations in the GTA and Ottawa. Clinics are conveniently located in popular shopping centers, including Hillcrest Mall, Square One, CF Sherway Gardens, Scarborough Town Centre, Rideau Centre, Union Station and CF Markville. These limited-edition Kits are available on a first come, first served basis.

“These kits combine our best-selling products, bundled to address the most relevant skin concerns we’re seeing among our clients,” says Christina Ho, Senior Brand & LAM Manager at Laser Clinics Canada. “With several price points available, the kits offer excellent value and suit a variety of gift-giving needs, from those new to cosmeceuticals to those looking to level up their skincare routine. What’s more, these kits are priced with a savings of up to 33 per cent so gift givers can save during the holiday season.

There are two kits to select from, each designed to address key skin concerns and each with a unique theme — Brightening Basics and Hydration Heroes.

Brightening Basics is a mix of everyday essentials for glowing skin for all skin types. The bundle comes in a sleek pink, reusable case and includes three full-sized products: 200ml gentle cleanser, 50ml Moisture Defence (normal skin) and 30ml1% Hyaluronic Complex Serum. The Brightening Basics kit is available at $129, a saving of 33 per cent.

Hydration Heroes is a mix of hydration essentials and active heroes that cater to a wide variety of clients. A perfect stocking stuffer, this bundle includes four deluxe products: Moisture 15 15 ml Defence for normal skin, 10 ml 1% Hyaluronic Complex Serum, 10 ml Retinol Serum and 50 ml Expert Squalane Cleansing Oil. The kit retails at $59.

In addition to the 2024 Holiday Gifts Kits, gift givers can easily add a Laser Clinic Canada gift card to the mix. Offering flexibility, recipients can choose from a wide range of treatments offered by Laser Clinics Canada, or they can expand their collection of exclusive Skinstitut products.

 

Brightening Basics 2024 Holiday Gift Kit by Skinstitut, available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.

Hydration Heroes 2024 Holiday Gift Kit by Skinstitut – available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.

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Here is how to prepare your online accounts for when you die

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LONDON (AP) — Most people have accumulated a pile of data — selfies, emails, videos and more — on their social media and digital accounts over their lifetimes. What happens to it when we die?

It’s wise to draft a will spelling out who inherits your physical assets after you’re gone, but don’t forget to take care of your digital estate too. Friends and family might treasure files and posts you’ve left behind, but they could get lost in digital purgatory after you pass away unless you take some simple steps.

Here’s how you can prepare your digital life for your survivors:

Apple

The iPhone maker lets you nominate a “ legacy contact ” who can access your Apple account’s data after you die. The company says it’s a secure way to give trusted people access to photos, files and messages. To set it up you’ll need an Apple device with a fairly recent operating system — iPhones and iPads need iOS or iPadOS 15.2 and MacBooks needs macOS Monterey 12.1.

For iPhones, go to settings, tap Sign-in & Security and then Legacy Contact. You can name one or more people, and they don’t need an Apple ID or device.

You’ll have to share an access key with your contact. It can be a digital version sent electronically, or you can print a copy or save it as a screenshot or PDF.

Take note that there are some types of files you won’t be able to pass on — including digital rights-protected music, movies and passwords stored in Apple’s password manager. Legacy contacts can only access a deceased user’s account for three years before Apple deletes the account.

Google

Google takes a different approach with its Inactive Account Manager, which allows you to share your data with someone if it notices that you’ve stopped using your account.

When setting it up, you need to decide how long Google should wait — from three to 18 months — before considering your account inactive. Once that time is up, Google can notify up to 10 people.

You can write a message informing them you’ve stopped using the account, and, optionally, include a link to download your data. You can choose what types of data they can access — including emails, photos, calendar entries and YouTube videos.

There’s also an option to automatically delete your account after three months of inactivity, so your contacts will have to download any data before that deadline.

Facebook and Instagram

Some social media platforms can preserve accounts for people who have died so that friends and family can honor their memories.

When users of Facebook or Instagram die, parent company Meta says it can memorialize the account if it gets a “valid request” from a friend or family member. Requests can be submitted through an online form.

The social media company strongly recommends Facebook users add a legacy contact to look after their memorial accounts. Legacy contacts can do things like respond to new friend requests and update pinned posts, but they can’t read private messages or remove or alter previous posts. You can only choose one person, who also has to have a Facebook account.

You can also ask Facebook or Instagram to delete a deceased user’s account if you’re a close family member or an executor. You’ll need to send in documents like a death certificate.

TikTok

The video-sharing platform says that if a user has died, people can submit a request to memorialize the account through the settings menu. Go to the Report a Problem section, then Account and profile, then Manage account, where you can report a deceased user.

Once an account has been memorialized, it will be labeled “Remembering.” No one will be able to log into the account, which prevents anyone from editing the profile or using the account to post new content or send messages.

X

It’s not possible to nominate a legacy contact on Elon Musk’s social media site. But family members or an authorized person can submit a request to deactivate a deceased user’s account.

Passwords

Besides the major online services, you’ll probably have dozens if not hundreds of other digital accounts that your survivors might need to access. You could just write all your login credentials down in a notebook and put it somewhere safe. But making a physical copy presents its own vulnerabilities. What if you lose track of it? What if someone finds it?

Instead, consider a password manager that has an emergency access feature. Password managers are digital vaults that you can use to store all your credentials. Some, like Keeper,Bitwarden and NordPass, allow users to nominate one or more trusted contacts who can access their keys in case of an emergency such as a death.

But there are a few catches: Those contacts also need to use the same password manager and you might have to pay for the service.

___

Is there a tech challenge you need help figuring out? Write to us at onetechtip@ap.org with your questions.

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Pediatric group says doctors should regularly screen kids for reading difficulties

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The Canadian Paediatric Society says doctors should regularly screen children for reading difficulties and dyslexia, calling low literacy a “serious public health concern” that can increase the risk of other problems including anxiety, low self-esteem and behavioural issues, with lifelong consequences.

New guidance issued Wednesday says family doctors, nurses, pediatricians and other medical professionals who care for school-aged kids are in a unique position to help struggling readers access educational and specialty supports, noting that identifying problems early couldhelp kids sooner — when it’s more effective — as well as reveal other possible learning or developmental issues.

The 10 recommendations include regular screening for kids aged four to seven, especially if they belong to groups at higher risk of low literacy, including newcomers to Canada, racialized Canadians and Indigenous Peoples. The society says this can be done in a two-to-three-minute office-based assessment.

Other tips encourage doctors to look for conditions often seen among poor readers such as attention-deficit hyperactivity disorder; to advocate for early literacy training for pediatric and family medicine residents; to liaise with schools on behalf of families seeking help; and to push provincial and territorial education ministries to integrate evidence-based phonics instruction into curriculums, starting in kindergarten.

Dr. Scott McLeod, one of the authors and chair of the society’s mental health and developmental disabilities committee, said a key goal is to catch kids who may be falling through the cracks and to better connect families to resources, including quicker targeted help from schools.

“Collaboration in this area is so key because we need to move away from the silos of: everything educational must exist within the educational portfolio,” McLeod said in an interview from Calgary, where he is a developmental pediatrician at Alberta Children’s Hospital.

“Reading, yes, it’s education, but it’s also health because we know that literacy impacts health. So I think that a statement like this opens the window to say: Yes, parents can come to their health-care provider to get advice, get recommendations, hopefully start a collaboration with school teachers.”

McLeod noted that pediatricians already look for signs of low literacy in young children by way of a commonly used tool known as the Rourke Baby Record, which offers a checklist of key topics, such as nutrition and developmental benchmarks, to cover in a well-child appointment.

But he said questions about reading could be “a standing item” in checkups and he hoped the society’s statement to medical professionals who care for children “enhances their confidence in being a strong advocate for the child” while spurring partnerships with others involved in a child’s life such as teachers and psychologists.

The guidance said pediatricians also play a key role in detecting and monitoring conditions that often coexist with difficulty reading such as attention-deficit hyperactivity disorder, but McLeod noted that getting such specific diagnoses typically involves a referral to a specialist, during which time a child continues to struggle.

He also acknowledged that some schools can be slow to act without a specific diagnosis from a specialist, and even then a child may end up on a wait list for school interventions.

“Evidence-based reading instruction shouldn’t have to wait for some of that access to specialized assessments to occur,” he said.

“My hope is that (by) having an existing statement or document written by the Canadian Paediatric Society … we’re able to skip a few steps or have some of the early interventions present,” he said.

McLeod added that obtaining specific assessments from medical specialists is “definitely beneficial and advantageous” to know where a child is at, “but having that sort of clear, thorough assessment shouldn’t be a barrier to intervention starting.”

McLeod said the society was partly spurred to act by 2022’s “Right to Read Inquiry Report” from the Ontario Human Rights Commission, which made 157 recommendations to address inequities related to reading instruction in that province.

He called the new guidelines “a big reminder” to pediatric providers, family doctors, school teachers and psychologists of the importance of literacy.

“Early identification of reading difficulty can truly change the trajectory of a child’s life.”

This report by The Canadian Press was first published Oct. 23, 2024.

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